by Dr. Megan Rybarczyk, EM PGY3
In December 2015, I completed a teaching elective with an organization called the Global Emergency Care Collaborative (GECC) in Masaka, Uganda. The program is working to train mid-level Emergency Care Providers (ECPs) in Uganda, where currently no other formal training for emergency care at any level (including physicians) exists. GECC was started in 2008 by US emergency physicians in Nyakibale, Uganda, by training several classes of nurses who now serve as trainers for new classes of students. GECC is now actively collaborating with the national Ministry of Health and a regional university (Mbarara University) to expand into a formal national level training center for a two year Diploma level ECP midlevel program. The new site, at the Masaka Regional Government Referral Hospital, currently has three of GECC’s veteran ECPs instructing six trainees in a three-month preparatory course before the formal Diploma program begins. It was in this that I participated during my elective.
My month at the Masaka site was very busy. The majority of my time (eight to twelve hours a day, six days a week) was spent teaching at the bedside in the Emergency Department – teaching both ECP Trainers(on everything from clinical topics and the logistics of running an Emergency Department to how to teach) and trainees (mostly clinical topics). One topic of particular interest to both the ECP Trainers and their trainees was ultrasound. Given the lack of other forms of radiology (some ultrasound and radiography only during the day; no CT or MRI), the ECP Trainers and trainees were eager to learn this skill. Other areas of emphasis included efficient history/physical exam skills, documentation, the assessment of trauma patients, pain management, and antibiotic stewardship.
In addition to bedside teaching, I condensed three lectures on respiratory emergencies in adults and children from the GECC curriculum into two and assisted the ECPs with giving these lectures to the trainees. I ran three simulation cases; two of which I authored myself. I assisted with the creation and delivery of a hospital-wide CME on shock. Finally, I created three new lectures: one on a few techniques for regional anesthesia, which I instructed to the trainees, and two CME lectures (interpreting laboratory tests and anti-hypertensive medications), which were instructed to the ECP Trainers. Finally, I worked with the Program Director to help make improvements to the department as a whole (e.g. posting reference materials in the department, obtaining/fixing necessary equipment/supplies, working on department/patient/chart organization and flow).
Again, it was a very busy and challenging month, but it was also an incredible educational experience not only regarding the unique and sometimes difficult pathology in the patient population, the relatively high volume of patients to be managed by the limited staffing of the hospital, and the need to adapt to a very low resource setting (despite being the regional government referral hospital) but also in having the time and the opportunity work to adapt, to expand, and to improve my teaching abilities.
I would highly recommend this elective to anyone with interests not only in education and in Global Health/working in resource-limited settings but also in department administration. As the program becomes more established in Masaka and as the volume of the Emergency Department continues to grow, this will be a much needed area of expertise among volunteers.
Overall, an excellent elective – not only due to the exceptional educational experience, but also due to the great program staff with which to work and the ease of organizing the elective within the confines of a busy resident’s schedule. I will definitely look into volunteering with the organization again, and do not hesitate to contact myself (Megan.Rybarczyk@bmc.org) or the Volunteer Coordinator (firstname.lastname@example.org) if you have an interest in organizing a similar experience.